OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES Post Office Box 53277 Oklahoma City, OK 73152 (405) 522-3908 TITLE 450 Chapter 17. Standards and Criteria for Community Mental Health Centers Effective July 1, 2003 Authority: Oklahoma Board of Mental Health and Substance Abuse Services; 43A O.S. 2-101, 3-306, 3-306.1 and 3-315 History: Codified 7-1-96; Added at 13 OK Reg 2741, effective 7-1-96; Amended at 14 OK Reg 1919 effective 05/27/97; Amended at 16 OK Reg 1494, effective 07/01/99; Amended at 17 OK Reg 2127, effective 07-01-2000; Added Emergency Rules, effective 10-13-2000; Amended at 18 OK Reg 2658, effective 07/0101; Amended at 19 OK Reg 2333; Amended at 20 OK Reg 653, effective 02/27/03; Amended at 20 OK Reg1303, effective 07/01/03. Unofficial Copy Official copies of administrative rules can be obtained only from the Office of Administrative Rules, Secretary of State. The official rules are the text accepted by the Oklahoma Secretary of State for publication in the Oklahoma Register and the Oklahoma Administrative Code as required by 75 O.S. 250 et seq. ODMHSAS has attempted to insure the text within this publication is the same as that on file with the Secretary of State. Any differences will be decided in favor of the text on file with the Secretary of State. This publication includes emergency rule revocations in effect February 27, 2003 and permanent rules in effect July 1, 2003.
TABLE OF CONTENTS SUBCHAPTER 1. GENERAL PROVISIONS...Page 8 450:17-1-1. Purpose 450:17-1-2. Definitions 450:17-1-3. Meaning of verbs in rules 450:17-1-4. Annual review of standards and criteria 450:17-1-5. New Standards and criteria [REVOKED] 450:17-1-6. Services 450:17-1-7. Applicability SUBCHAPTER 3. REQUIRED SERVICES... Page 17 Part 1. Required Services 450:17-3-1. Required core services 450:17-3-2. Core community mental health services 450:17-3-3. Availability of services Part 3. Screening Intake and Referral 450:17-3-21. Screening intake and assessment services 450:17-3-22. Screening intake and assessment services, access or referral to needed services Part 5. Emergency Services 450:17-3-41. Emergency services 450:17-3-42. Emergency examinations 450:17-3-43. Emergency examinations, staffing Part 7. Outpatient Counseling Services 450:17-3-61. Outpatient counseling services 450:17-3-62. Outpatient counseling services, substance abuse Part 9. Medication Clinic Services 450:17-3-81. Medication clinic services 450:17-3-82. Medication clinic, medication monitoring 450:17-3-83. Medication clinic, error rates 450:17-3-84. Availability of medications in a CMHC's community living setting 450:17-3-85. Pharmacy Services Part 11. Case Management 450:17-3-101. Case management services, adult 450:17-3-101.1. Case management services, child, adolescent and family 450:17-3-102. Case management services, locale and frequency Unofficial Copy: OAC Title 450:17 2 Effective 07/01/03
450:17-3-103. Case management services for the hospitalized consumer Unofficial Copy: OAC Title 450:17 3 Effective 07/01/03
450:17-3-104. Case management services client evaluation [REVOKED] 450:17-3-105. Case management services, client outcome [REVOKED] 450:17-3-106 Case management services, staff credentials Part 13. ODMHSAS Operated Psychiatric Hospitals 450:17-3-121. Admissions to ODMHSAS operated psychiatric hospitals [REVOKED] 450:17-3-122. Persons presenting at a state-operated inpatient psychiatric unit for purpose of admission, pre-screening of Part 15. Adult Day Programs 450:17-3-141. Day programs - day treatment and psychosocial rehabilitation programs 450:17-3-142. Day programs - day treatment 450:17-3-143. Therapeutic day programs - day treatment, CMHC evaluation of [REVOKED] 450:17-3-144. Day programs psychosocial rehabilitation services 450:17-3-144.1 Exception day programs, psychosocial rehabilitation program scoring 450:17-3-145. Therapeutic day programs - psychosocial services, evaluation of [REVOKED] Part 17. Services To Homeless Individuals 450:17-3-161. Services to homeless individuals Part 19. Pharmacy Services 450:17-3-181. Pharmacy services [AMENDED AND RENUMBERED to 450:17-3-85] SUBCHAPTER 5. OPTIONAL SERVICES... Page 28 Part 1. Applicability 450:17-5-1. Applicability Part 3. Intensive Case Management 450:17-5-11. Intensive case management services [REVOKED] 450:17-5-12. Intensive case management services, clients' improved functioning [REVOKED] Part 5. Homebased Services To Children And Adolescents 450:17-5-22. Homebased services to children and adolescents, family preservation 450:17-5-23. Homebased services to children and adolescents, family satisfaction [REVOKED] 450:17-5-24. Homebased services to children and adolescents, out-of-home placements [REVOKED] Unofficial Copy: OAC Title 450:17 4 Effective 07/01/03
Part 7. Day Treatment Services, Children And Adolescents 450:17-5-34. Day treatment services for children and adolescents 450:17-5-35. Day treatment services for children and adolescents, evaluation of [REVOKED] 450:17-5-36. Therapeutic nursery [REVOKED] Part 9. Vocational Employment Services 450:17-5-45. Vocational employment services 450:17-5-46. Vocational employment services, follow-up evaluation [REVOKED] Part 11. Community Living Programs 450:17-5-56. Community living programs 450:17-5-57. Community living programs, client orientation [REVOKED] 450:17-5-58. Community living programs, evaluation of [REVOKED] 450:17-5-59. Community living programs, vocational components [REVOKED] 450:17-5-60. Independent living training programs 450:17-5-61. Independent living training program, staffing 450:17-5-62. Independent living training program, licensure 450:17-5-63. Independent living facilities and supervised apartment, disaster and accident planning and preparedness 450:17-5-64. Supervised apartment and housing programs 450:17-5-65. Community living environment 450:17-5-66. Permanent supported apartment or housing programs, consumer housing assistance 450:17-5-67. Permanent supported apartment or housing programs, monthly contacts and activities 450:17-5-67.1 Permanent supported apartment or housing programs, monthly contacts and activities 450:17-5-67.2 Permanent supported apartment or housing programs, consumer housing assistance, documentation of 450:17-5-67.3 Permanent congregate housing programs 450:17-5-68. Community lodge programs [REVOKED] 450:17-5-69. Community lodge programs, client participation [REVOKED] 450:17-5-70. Community lodge programs, financial resources of clients [REVOKED] 450:17-5-71. Community lodge programs, housing provisions [REVOKED] 450:17-5-72. Sponsor family programs [REVOKED] Part 13. Crisis Stabilization 450:17-5-81. Certification required for provision of crisis intervention and stabilization services. 450:17-5-82. Intensive crisis stabilization programs [REVOKED] 450:17-5-83. Intensive crisis stabilization programs, triage response [REVOKED] Unofficial Copy: OAC Title 450:17 5 Effective 07/01/03
450:17-5-84. Intensive crisis stabilization procedures, psychiatric crisis care services [REVOKED] 450:17-5-85. Intensive crisis stabilization programs, drug/alcohol crisis care services [REVOKED] Part 15. Inpatient Services 450:17-5-95. Inpatient services within the community mental health setting 450:17-5-96. Inpatient services within the community mental health setting, service issues 450:17-5-97. Inpatient services within the community mental health setting, clinical medical health issues 450:17-5-98. Inpatient services within the community mental health setting, activity services 450:17-5-99. Inpatient services within the community mental health setting, environment 450:17-5-100. Mechanical restraints Part 17. Psychiatric Inpatient Services In General Hospitals 450:17-5-110. Psychiatric treatment programs/units in general hospitals [REVOKED] Part 19. Program for Assertive Community Treatment 450:17-5-111. General program description and target population [REVOKED] 450:17-5-112. Admission criteria [REVOKED] 450:17-5-113. Discharge criteria [REVOKED] 450:17-5-114. Program Management and Capacity [REVOKED] 450:17-5-115. Staff communication and planning [REVOKED] 450:17-5-116. Clinical supervision [REVOKED] 450:17-5-117. Orientation and training [REVOKED] 450:17-5-118. Services [REVOKED] 450:17-5-119. Medication prescription, administration, monitoring, and documentation [REVOKED] 450:17-5-120. Rehabilitation [REVOKED] 450:17-5-121. Support services [REVOKED] 450:17-5-122. Staffing requirements [REVOKED] 450:17-5-123. Assessment and treatment planning [REVOKED] 450:17-5-124. Treatment planning [REVOKED] 450:17-5-125. Discharge [REVOKED] 450:17-5-126. PACT Consumer Clinical Records [REVOKED] 450:17-5-127. Programs for assertive community treatment Unofficial Copy: OAC Title 450:17 6 Effective 07/01/03
SUBCHAPTER 7. FACILITY CLINICAL RECORDS... Page 40 450:17-7-1. Clinical record keeping 450:17-7-2. Applicability 450:17-7-3. Basic requirements 450:17-7-4. Record access for clinical staff 450:17-7-5. Clinical record content, intake and assessment 450:17-7-6. Health and drug history 450:17-7-7. Psychosocial evaluation 450:17-7-8. Treatment plan 450:17-7-9. Medication record 450:17-7-10. Progress notes 450:17-7-11. Other records content 450:17-7-12. Discharge summary SUBCHAPTER 9. CONSUMER RECORDS AND CONFIDENTIALITY... Page 46 450:17-9-1. Confidentiality, mental health consumer information and records [REVOKED] 450:17-9-1.1. Confidentiality of mental health and drug or alcohol abuse treatment information 450:17-9-2. Confidentiality, substance abuse consumer information and records [REVOKED] SUBCHAPTER 11. CONSUMER RIGHTS... Page 48 450:17-11-1. Consumer rights, inpatient and residential 450:17-11-2. Consumer rights, outpatient services 450:17-11-3. Consumer's grievance policy 450:17-11-4. ODMHSAS Consumer Advocacy Division SUBCHAPTER 13. ORGANIZATIONAL MANAGEMENT... Page 53 450:17-13-1. Organizational and facility description 450:17-13-2. Information analysis and planning SUBCHAPTER 15. PERFORMANCE IMPROVEMENT AND QUALITY MANAGEMENT... Page 55 450:17-15-1. Quality assurance [REVOKED] 450:17-15-1.1. Performance improvement program 450:17-15-2. Written plan [REVOKED] Unofficial Copy: OAC Title 450:17 7 Effective 07/01/03
450:17-15-3. Quality assurance activities [REVOKED] 450:17-15-3.1. Quality improvement activities [REVOKED] 450:17-15-4. Monitoring and evaluation process [REVOKED] 450:17-15-5. Incident reporting SUBCHAPTER 17. UTILIZATION REVIEW... Page 57 450:17-17-1. Utilization review [REVOKED] 450:17-17-2. Written plan [REVOKED] 450:17-17-3. Method for identifying problems [REVOKED] SUBCHAPTER 19. HUMAN RESOURCES... Page 58 450:17-19-1. Personnel policies and procedures 450:17-19-2. Job descriptions 450:17-19-3. Utilization of volunteers SUBCHAPTER 21. STAFF DEVELOPMENT AND TRAINING... Page 60 450:17-21-1. Staff qualifications 450:17-21-2. Staff development 450:17-21-3. Annually required inservice training for all employees 450:17-21-4. First Aid and CPR training 450:17-21-5. CAPE training SUBCHAPTER 23. FACILITY ENVIRONMENT... Page 62 450:17-23-1. Facility environment SUBCHAPTER 25. GOVERNING AUTHORITY... Page 63 450:17-25-1. Documents of authority 450:17-25-2. Board composition SUBCHAPTER 27. SPECIAL POPULATIONS... Page 65 450:17-27-1. Americans with Disabilities Act of 1990 450:17-27-2. Human Immunodeficiency Virus (HIV), and Acquired Immunodeficiency Syndrome (AIDS) Unofficial Copy: OAC Title 450:17 8 Effective 07/01/03
CHAPTER 1. GENERAL PROVISIONS 450:17-1-1. Purpose (a) This chapter sets forth the Standards and Criteria used in the certification of Community Mental Health Centers and implements 43A O.S. 3-306.1, which authorizes the Board of Mental Health and Substance Abuse Services, or the Commissioner upon delegation by the Board, to certify Community Mental Health Centers. (b) The rules regarding the certification process including but not necessarily limited to application, feesand administrative sanctions are found in the Oklahoma Administrative Code, Title 450 Chapter 1, Subchapters 5 and 9. 450:17-1-2. Definitions The following words or terms, when used in this Chapter, shall have the following meaning, unless the context clearly indicates otherwise: "Abuse" means the causing or permitting of harm or threatened harm to the health, safety, or welfare of a resident by a staff responsible for the resident's health, safety, or welfare, including but not limited to: non-accidental physical injury or mental anguish; sexual abuse; sexual exploitation; use of mechanical restraints without proper authority; the intentional use of excessive or unauthorized force aimed at hurting or injuring the resident; or deprivation of food, clothing, shelter, or healthcare by a staff responsible for providing these services to a resident. "Adults who have a serious mental illness" are persons eighteen (18) years of age or older who meet the following criteria: (A) Currently or at any time during the past year have had a diagnosable mental, behavioral or emotional disorder of sufficient duration to meet criteria specified within DSM-IV with the exception of "V" codes, substance abuse disorders, and developmental disorders, unless they co-occur with another diagnosable serious mental illness; and (B) Based on a client assessment scale, has moderate impairment in at least four, severe impairment in two or extreme impairment in one of the following areas: (i) Feeling, mood and affect; (ii) Thinking; (iii) Family relationships; (iv) Interpersonal skills; (v) Role performance; (vi) Socio-legal; or (vii) Self care and basic needs; or (C) Has a duration of illness of at least one year and at least moderate impairment in two, or severe impairment in one of the following areas: (i) Feeling, mood and affect; (ii) Thinking; (iii) Family relationships; (iv) Interpersonal skills; (v) Role performance; (vi) Socio-legal; or Unofficial Copy: OAC Title 450:17 9 Effective 07/01/03
(vii) Self care and basic needs. "Case management services" means planned linkage, advocacy and referral assistance provided in partnership with a consumer to support that consumer in self sufficiency and community tenure and take place in the individual s home, in the community, or in the facility, in accordance with a treatment plan developed with and approved by the consumer and qualified staff. "Children who have a serious emotional disturbance" are persons under eighteen (18) years of age who meet the following criteria: (A) Possess a diagnosable, serious disorder under DSM-IV such as pervasive developmental disorder, childhood schizophrenia, schizophrenia of adult-type manifesting in adolescence, conduct disorder, affective disorder, other disruptive behaviors, or other disorders with serious medical implications such as eating disorders, or persistent involvement with alcohol or drugs; and (B) Based on a client assessment scale, has moderate impairment in at least four, severe impairment in two, or extreme impairment in one in the following areas: (i) Feeling, mood and affect; (ii) Thinking; (iii) Substance use; (iv) Family relationships; (v) Interpersonal skills; (vi) Role performance; (vii) Socio-legal; (viii) Self care and basic needs; or (ix) Caregiver resources; or (C) Has a duration of illness for at least one year and has a functioning level of moderate impairment in at least two, or severe impairment in one of the following areas: (i) Feeling, mood and affect; (ii) Thinking; (iii) Family relationships; (iv) Interpersonal skills; (v) Role performance; (vi) Socio-legal; or (vii) Self care and basic needs. "Creating A Positive Environment" or "CAPE" means a specific curriculum designed by ODMHSAS to train staff in verbal and non-verbal communication techniques in the management of selected and potentially problematic behaviors and to foster attitudes that promote the consumer's dignity and self-esteem in facility treatment settings. "Clinical privileging" means an organized method for treatment facilities to authorize an individual permission to provide specific care and treatment services to consumers within welldefined limits, based on the evaluation of the individual's license, education, training, experience, competence, judgment, and other credentials. Unofficial Copy: OAC Title 450:17 10 Effective 07/01/03
"Community living programs" means a range of rehabilitative housing options for persons not in crisis who need a special living arrangement and are broad enough to allow each consumer an opportunity to live in an atmosphere offering the degree of case management necessary while also providing incentives and encouragement for consumers to assume increasing responsibility for their lives and may include independent living training programs, supervised permanent supported apartments and housing, and family placement. "Community mental health center" or "CMHC" means a facility offering a comprehensive array of community-based mental health services, including but not limited to, inpatient treatment, outpatient treatment, partial hospitalization, emergency care, consultation and education; and, certain services at the option of the center, including, but not limited to, prescreening, rehabilitation services, pre-care and aftercare, training programs, and research and evaluation. "Consumer" means an individual, adult or child, who has applied for, is receiving or has received evaluation or treatment services from a facility operated or certified by ODMHSAS or with which ODMHSAS contracts and includes all persons referred to in OAC Title 450 as client(s) or patient(s) or resident(s) or a combination thereof. "Consumer advocacy" includes all activities on behalf of the consumer to assist with or facilitate resolution of problems in the acquisition of resources or services needed by the consumer. "Consumer committee" or "consumer government" means any established group within the facility comprised of consumers, led by consumers and meets regularly to address consumer concerns to support the overall operations of the facility. "Crisis Intervention" means an immediately available service to meet the psychological, physiological and environmental needs of individuals who are mentally ill. "Crisis stabilization" means emergency, psychiatric, and substance abuse services for the resolution of crisis situations and may include placement of an individual in a protective environment, basic supportive care, and medical assessment, referral provided in a ODMHSAS certified facility having nursing and medical support available. "Critical incident" means an occurrence or set of events inconsistent with the routine operation of the facility, or the routine care of a consumer. Critical incidents specifically include but are not necessarily limited to the following: adverse drug events; self-destructive behavior; deaths and injuries to consumers, staff and visitors; medication errors; consumers that are absent without leave (AWOL); neglect or abuse of a consumer; fire; unauthorized disclosure of information; damage to or theft of property belonging to a consumers or the facility; other unexpected occurrences; or events potentially subject to litigation. A critical incident may involve multiple individuals or results. "DSM" means the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. "Day treatment" is a structured, comprehensive program designed to improve or maintain consumers ability to function in the community. Unofficial Copy: OAC Title 450:17 11 Effective 07/01/03
"Emergency detention" means the detention of a person who appears to be a person requiring treatment in a facility approved by the Commissioner of Mental Health and Substance Abuse Services as appropriate for such detention after the completion of an emergency examination and a determination that emergency detention is warranted for a period not to exceed seventy-two (72) hours, excluding weekends and holidays, except upon a court order authorizing detention beyond a seventy-two-hour period or pending the hearing on a petition requesting involuntary commitment or treatment as provided by 43A of the Oklahoma Statutes. "Emergency examination" means the examination of a person who appears to be a mentally ill person, an alcohol-dependent person, or drug-dependent person and a person requiring treatment, and whose condition is such that it appears that emergency detention may be warranted, by a licensed mental health professional to determine if emergency detention of the person is warranted. "Facility" means community mental health center. "Hard of hearing" is any degree of hearing loss which interferes with the individual's ability to communicate without some form of specialized accommodation which may include, but not be limited to: hearing aids, sign language interpreters, assistive listening devices, or communication through speech reading. The hearing loss of those individuals needing special services may range from mild, 25 to 45 decibels in the better functioning ear, to profound, 90 decibels or more. "Historical timeline" means a method by which a specialized form is used to gather, organize and evaluate information about significant events in a consumer's life, experience with mental illness, and treatment history. "Homebased services to children and adolescents" means intensive therapeutic services provided in the home to children for the purpose of reduction of psychiatric impairment and preventing removal of the child to a more restrictive setting for care. Services include a planned combination of procedures developed by a team of qualified mental health professionals, including a physician. "Independent living skills, assistance in development of" means all activities directed at assisting individuals in the development of skills necessary to live and function within the community, e.g., consumer education on topics such as hygiene, cooking, budgeting, meal planning, housecleaning and when clinically indicated, side-by-side work with the consumer in a normalized setting and prevocational and vocational activities. "Integrated Client Information System" or "ICIS" is a comprehensive management information system based on national standards for mental health and substance abuse databases. It is a repository of diverse data elements that provide information about organizational concepts, staffing patterns, consumer profiles, program or treatment focus, and many other topics of interest to clinicians, administrators and consumers. It includes unique identifiers for agencies, staff and consumers that provide the ability to monitor the course of consumer services throughout the statewide DMHSAS network. ICIS collects data from hospitals, community mental health centers, substance abuse agencies, domestic violence service providers, residential care facilities, prevention programs, and centers for the homeless which are operated or funded in part by DMHSAS. Unofficial Copy: OAC Title 450:17 12 Effective 07/01/03
"Independent living training" means a supervised place of temporary transitional residence for mental health consumers participating in an independent living training program before moving to a more independent living situation. These facilities are intended for participation by mental health consumers who have recently been released from an institution, and who need short-term training and support before entering an independent living situation. "Job development services" means strategies which market the CMHC rehabilitation services and assist employers in facilitating the successful employment of individuals with psychiatric disabilities. Marketing, in this context, is defined as an ongoing, continuous approach which enables the rehabilitation unit to identify employer needs, refocus resources and management structures as needed and improve services to consumers and employers which satisfy those needs for the purpose of job development services such as developing long-term relationships between the agency and employers which will lead to more and better job opportunities for persons with psychiatric disabilities. "Licensed mental health professional" or "LMHP" means: (A) a psychiatrist who is a diplomate of the American Board of Psychiatry and Neurology; (B) a licensed Doctor of Medicine or Doctor of Osteopathy who has received specific training for and is experienced in performing mental health therapeutic, diagnostic, or counseling functions; (C) a licensed clinical psychologist; (D) a licensed professional counselor as defined in Section 1906 of Title 59 of the Oklahoma Statutes; (E) a person licensed as a clinical social worker pursuant to the provisions of Section 1250 et seq. of Title 59 of the Oklahoma Statutes; (F) a licensed marital and family therapist as defined in Section 1925.2 of Title 59 of the Oklahoma Statutes; (G) a licensed behavioral practitioner as defined in Section 1931 of Title 59 of the Oklahoma Statutes; or (H) an advanced practice nurse as defined in Section 567.3a of Title 59 of the Oklahoma Statutes specializing in mental health. "Linkage" refers to the communication and coordination with other service providers to assure timely appropriate referrals between the CMHC and other providers. "Medical resident" means a physician who is a graduate of a school of medicine or osteopathy and who is receiving specialized training in a teaching hospital under physicians who are certified in that specialty. "Medication error" means an error in prescribing, dispensing or administration of medication, regardless if the error reached the consumer, e.g., omission of prescribed drugs, giving drugs not prescribed, prescribing inappropriate drugs, prescribing or administering incorrect dosages, incorrectly filling or labeling prescriptions, incorrectly transcribing medication orders. "ODMHSAS" means the Oklahoma Department of Mental Health and Substance Abuse Services. Unofficial Copy: OAC Title 450:17 13 Effective 07/01/03
"Oklahoma Administrative Code" or "OAC" means the publication authorized by 75 O.S. 256 known as The Oklahoma Administrative Code, or, prior to its publication, the compilation of codified rules authorized by 75 O.S. 256(A)(1)(a) and maintained in the Office of Administrative Rules. "Performance Improvement" or "PI" means an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of consumers and others. Synonyms, and near synonyms include continuous quality improvement, continuous improvement, organization-wide quality improvement and total quality management. "Permanent supported apartment or housing programs" means a permanent residential program for mental health consumers in which the agency facilitates placement of, and provides intensive case management services to, individuals who reside in an apartment or house, either individually or shared. Staffs are not required on-site, but are on-call for residents. These facilities are intended for Mental Health consumers who desire and are evaluated as being capable of, living in a house or apartment without on-site supervision. "Program for Assertive Community Treatment" or "PACT" is a clinical program that provides continuous treatment, rehabilitation, and support services to persons with mental illness in settings that are natural to the consumer. "Progress notes" mean a chronological written description of services provided to a consumer and documentation of the consumer s response related to the intervention plan. "Psychosocial evaluations" are in-person interviews conducted by professionally trained personnel designed to elicit historical and current information regarding the behavior and experiences of an individual, and are designed to provide sufficient information for problem formulation and intervention. "Psychosocial rehabilitation" means a program focused around a clubhouse or other center offering services to members in the areas of socialization and recreation, vocation, residential and education. These services are directed toward helping members develop needed skills and provide environmental supports necessary to function in the community. "Rehabilitation assessment services" means a process utilized to determine the individual's functional work-related abilities and vocational preferences for the purpose of rehabilitation assessment the identification of the skills and environmental supports needed by the individual in order to function more independently in an employment setting, and to determine the nature and intensity of services which may be necessary to obtain and retain employment. "Residential treatment" means a structured, 24-hour supervised treatment program for individuals who are mentally ill with a minimum of twenty-one (21) hours of therapeutic services provided per week with the emphasis on stabilization and rehabilitation for transfer to a less restrictive environment. Stay in the program is time limited. "Restraint" refers to manual, mechanical, and chemical methods that are intended to restrict the movement or normal functioning of a portion of an individual's body. Unofficial Copy: OAC Title 450:17 14 Effective 07/01/03
"Sentinel event" is a type of critical incident that is an unexpected occurrence involving the death or serious physical or psychological injury to a consumer, or risk thereof. Serious injury specifically includes loss of limb or function. The phrase "or risk thereof" includes a variation in approved processes which could carry a significant chance of a serious adverse outcome to a consumer. These events signal the need for immediate investigation and response. Sentinel events include, but are not limited to: suicide, homicide, criminal activity, assault and other forms or violence, including domestic violence or sexual assault, and adverse drug events resulting in serious injury or death. "Serioius Emotional Disturbance" or "SED" means a child from birth to eighteen years of age who does not have a primary diagnosis of a developmental disorder(s) and meets the following criteria: (A) possesses a diagnosable, serious disorder under DSM-IV such as pervasive developmental disorder, childhood schizophrenia, schizophrenia of adult-type manifesting in adolescence, conduct disorder, affective disorder, other disruptive behaviors, or other disorders with serious medical implications such as eating disorders, or persistent involvement with alcohol or drugs; and (B) has a functioning level which includes: a moderate impairment in at least four; severe impairment in two; or extreme impairment in one of the following areas; OR has an illness with a duration of at least one year and has a functioning level of moderate impairment in at least two; or a severe impairment in one of the following areas: (i) Feeling, mood and affect include: an uncontrolled emotion that is clearly disruptive in its effects on other aspects of a child's life; frustration, anger, loneliness and boredom persist beyond the precipitating situation; and symptoms of distress are pervasive and do not respond to encouragement or reassurance; (ii) Thinking processes include: daily life is disrupted due to impaired thoughts and thinking process; an inability to distinguish between fantasy and reality exists; and unusual thoughts or attachments to objects are present; (iii) Substance use includes: frequent difficulties due to substance use and repeated use of substances causing difficulty at home or in school; (iv) Family situation includes: disruption of family relationships or family does not function as a unit and experiences frequent turbulence; relationships that exist are psychologically devastating; the child does not have family support and is abused or neglected; (v) Interpersonally the child will: have a severe inability to establish or maintain a personal social support system; lacks close friends or group affiliations; is socially isolated; and lacks age appropriate social skills; (vi) Role performance consists of: frequent disruption of role performance and the individual is unable to meet usual expectations; has persistent behavior problems; and has failure, or been suspended or expelled from school; (vii) Socio-legal issues include: inability to maintain conduct within the limits prescribed by law, rules and strong mores; shows little concern for consequences of actions; and delinquent acts or frequent contact with law enforcement exists; (viii) Self care and basic needs are such that the ability to care for self is Unofficial Copy: OAC Title 450:17 15 Effective 07/01/03
considerably below expectation. (ix) Caregiver resources are: the caregiver has difficulties in providing for the child's basic needs; or the developmental needs are such that there is a negative impact on the child's level of functioning; OR "Service area" means a geographic area established by the Department of Mental Health and Substance Abuse Services for support of mental health and substance abuse services [43A O.S. 3-302(1)]. "Socialization" means all activities which encourage interaction and the development of communication, interpersonal, social and recreational skills and can include consumer education. "Special need, persons with" means any persons with a condition which is considered a disability or impairment under the "American with Disabilities Act of 1990" including, but not limited to the deaf or hard of hearing, visually impaired, physically disabled, developmentally disabled, persons with disabling illness, persons with mental illness. See "Americans with Disabilities Handbook," published by U.S. Equal Employment Opportunity Commission and U.S. Department of Justice. "Supervised apartment or housing programs" means a temporary or permanent residential program for mental health consumers, in which the consumer resides in one of a group of apartments. These facilities are intended for use by mental health consumers who desire and are evaluated as being capable of living in an apartment setting, without on-site staff. "Supportive services" refers to assistance with the development of problem-solving and decision-making skills to maintain or achieve optimal functioning within the community and can include consumer education. "Vocational placement services" means a process of developing or creating an appropriate employment situation matched to the functional abilities and choices of the individual for the purpose of vocational placement services such as the identification of employment positions, conducting job analysis, matching individuals to specific jobs, facilitating job expansion or advancement and communicating with employers about training needs. "Vocational preparation services" means services that focus on development of general work behavior for the purpose of vocational preparation such as the utilization of individual or group work-related activities to assist individuals in understanding the meaning, value and demands of work; to modify or develop positive work attitudes, personal characteristics and work behaviors; to develop functional capacities; and to obtain optimum levels of vocational development. 450:17-1-3. Meaning of verbs in rules The attention of the facility is drawn to the distinction between the use of the words "shall," "should," and "may" in this chapter: (1) "Shall" is the term used to indicate a mandatory statement, the only acceptable method under the present standards. (2) "Should" is the term used to reflect the most preferable procedure, yet allowing for the Unofficial Copy: OAC Title 450:17 16 Effective 07/01/03
use of effective alternatives. Unofficial Copy: OAC Title 450:17 17 Effective 07/01/03
(3) "May" is the term used to reflect an acceptable method that is recognized but not necessarily preferred. 450:17-1-4. Annual review of standards and criteria This chapter shall be reviewed annually by the ODMHSAS. 450:17-1-5. New standards and criteria [REVOKED] 450:17-1-6. Services All facilities providing services shall have a group of services herein designated as core services. CMHCs may have specific additional services herein designated as optional services. Optional services may be an ODMHSAS contractual requirement(s). (1) Core services are: (A) Screening, intake and referral; (B) Emergency services, which include crisis intervention and emergency detention if the CMHC is also certified as a community based structured crisis center or provides acute inpatient services; (C) Medication clinic services; (D) Case management (adult and juvenile); (E) Adult day programs; (F) Outpatient counseling; (G) Admitting to state-operated inpatient psychiatric units; and (H) Services to homeless individuals. (2) Optional services are: (A) Homebased services to children and adolescents; (B) Day treatment services to children and adolescents; (C) Vocational employment services; (D) Community living programs; (E) Independent living training programs; (F) Supervised apartment or housing programs; (G) Permanent sponsored apartment or housing programs; (H) Crisis stabilization; (I) Inpatient services within the CMHC setting; and (J) Program for Assertive Community Treatment. 450:17-1-7. Applicability The standards and criteria for services as subsequently set forth in this chapter are applicable to CMHCs as stated in each subchapter. Unofficial Copy: OAC Title 450:17 18 Effective 07/01/03
SUBCHAPTER 3. REQUIRED SERVICES PART 1. REQUIRED SERVICES 450:17-3-1. Required core services The services in this subchapter are core services, and are required of each CMHC. 450:17-3-2. Core community mental health services (a) Each CMHC shall provide the following services: (1) Screening intake and referral services; (2) Emergency services; (3) Outpatient counseling; (4) Case management services; (5) Admitting to ODMHSAS operated psychiatric hospitals; (6) Adult day programs; (7) Medication clinic services; (8) Service to homeless individuals. (b) Compliance with 450:17-3-2 shall be determined by a review of the following: (1) On-site observation; (2) Staff interviews; (3) Written materials; (4) Program policies; (5) Evaluations; (6) ICIS data; and (7) Clinical records. 450:17-3-3. Availability of services (a) The core services shall be available to individuals regardless of their work schedule. (1) All services provided on an outpatient basis shall be routinely available at least forty (40) hours per week. (2) CMHC policy shall provide an arrangement for hours in addition to 8:00 AM - 5:00 PM according to the needs of consumers. This applies to the main CMHC location and full time satellite offices with two (2) or more full time employed clinical staff. (3) For CMHCs not providing 24 hour on-site services, hours of operation shall be conspicuously posted. (b) Compliance with 450:17-3-3 shall be determined by a review of the following: schedules; posting of hours; policy and procedures; and consumer needs assessment. PART 3. SCREENING INTAKE AND REFERRAL 450:17-3-21. Screening intake and assessment services (a) CMHC policy and procedure shall require a comprehensive assessment of each Unofficial Copy: OAC Title 450:17 19 Effective 07/01/03
consumer s service needs is completed in a timely manner. Unofficial Copy: OAC Title 450:17 20 Effective 07/01/03
(b) Screening and intake services shall include a complete assessment of each consumer to determine clinical needs. This shall include but not be limited to an assessment of the following areas and needs: (1) Behavioral; (2) Emotional; (3) Physical; (4) Social and recreational; and (5) Vocational. (c) The consumer and family as appropriate shall be an active participant(s) in the intake and assessment process. (d) The CMHC shall have policy and procedures specific to each program service which dictate timeframes by when assessments must be completed and documented. In the event the consumer is not admitted and as a result the assessment is not included in the clinical record, the policy shall specify how screening and assessment information is maintained and stored. (e) Compliance with 450:17-3-21 shall be determined by a review of clinical records, and policy and procedures. 450:17-3-22. Screening intake and assessment services, access or referral to needed services (a) Written policy and procedures governing the intake and assessment services shall specify the following: (1) The information to be obtained on all applicants or referrals for admission; (2) The procedures for accepting referrals from outside agencies or organizations; (3) The procedure to be followed when an applicant or referral is found to be ineligible for admission; and (4) Methods of collection of information from family members, significant others or other social service agencies. (5) Methods for obtaining a physical examination or continued medical care where indicated. (6) Referral to other resources when the consumer has treatment or other service needs the facility cannot meet. (b) Compliance with 450:17-3-22 shall be determined by a review of the facility's written policy and procedures. PART 5. EMERGENCY SERVICES 450:17-3-41. Emergency services (a) CMHCs shall provide, on a twenty-four (24) hour basis, for psychiatric emergencies. (b) This service shall include the following: (1) 24-hour assessment and evaluation, including emergency examinations; (2) Availability of 24-hour inpatient referral; (A) CMHC staff shall be actively involved in the emergency services and referral Unofficial Copy: OAC Title 450:17 21 Effective 07/01/03
process to state-operated psychiatric inpatient units. (B) Referral to state-operated psychiatric inpatient units by the CMHC shall occur only after all other community resources are explored with the individual and family if family is available and the consumer gives written consent for release. (C) Prior notification to the state-operated psychiatric inpatient unit of all referrals from CMHCs is required. (3) Availability of assessment and evaluation in external settings. (4) Referral services, which shall include actively working with local sheriffs and courts regarding the appropriate referral process and appropriate court orders (43A O.S. 5-201 through 5-407); (5) CMHCs serving multiple counties shall provide or arrange for on-site assessment of persons taken into protective custody [43A O.S. 5-06(5)] in each county; (6) The CMHC's emergency telephone response time shall be less than fifteen (15) minutes from initial contact, unless there are extenuating circumstances; (7) Face-to-face assessment; and (8) Intervention and resolution. (b) Compliance with 450:17-3-41 shall be determined by a review of policy and procedures, and clinical records. 450:17-3-42. Emergency examinations (a) The CMHC shall provide or otherwise ensure the capacity for performing emergency examinations. This capacity must be available 24 hours per day, seven days a week. (b) Compliance with 450:17-3-42 shall be determined by a review of the following: policy and procedures; emergency contact records; clinical records; PI documentation; and staff on-call schedules. 450:17-3-43. Emergency examinations, staffing (a) Staff providing emergency examinations shall be an LMHP as defined in 43A O.S. 1-103 and meet the CMHC's privileging requirements for the provision of emergency services. (b) Compliance with 450:17-3-43 shall be determined by a review of clinical privileging records and personnel records. PART 7. OUTPATIENT COUNSELING SERVICES 450:17-3-61. Outpatient counseling services (a) Facilities that provide outpatient services shall offer a range of services to consumers based on their needs regarding emotional, social and behavioral problems. These outpatient counseling services shall be provided or arranged for, and shall include, but not be limited to the following: (1) Individual counseling; (2) Group counseling; (3) Marital or family counseling; (4) Psychological/psychometric evaluations or testing; and Unofficial Copy: OAC Title 450:17 22 Effective 07/01/03
(5) Psychiatric assessments. (b) Compliance with 450:17-3-61 shall be determined by a review of written policy and procedures; clinical records; and ICIS data reported by facilities. 450:17-3-62. Outpatient counseling services, substance abuse (a) Facilities shall provide outpatient substance abuse counseling services. (b) These services shall include the provision of Human Immunodeficiency Virus (HIV) education, training, and counseling services for drug dependent persons (43A O.S. 3-125.1), and every facility shall: (1) Provide educational sessions regarding HIV to such persons, and also make the sessions available to spouses or other sexual partners of the drug dependent person; and (2) Refer all drug dependent persons for HIV infection testing and counseling. (c) The HIV testing and counseling may be provided by the facility, or through a public or private organization for the testing or counseling services. All test results shall be maintained in the confidential manner prescribed by applicable state or federal statutes or regulations. (d) Compliance with 450:17-3-62 shall be determined by a review of the following: written policy and procedures; substance abuse consumer records; and other supporting facility records and documentation. PART 9. MEDICATION CLINIC SERVICES 450:17-3-81. Medication clinic services (a) Medication clinic services shall include an assessment of each individual's condition and needs; and an assessment of the effectiveness of those services. (b) CMHCs shall offer comprehensive medication clinic services to consumers in need of this service, including, but not limited to: (1) Prescribing or administering medication, including evaluation and assessment of the medication services provided. (2) Medication orders and administration: (A) Only licensed staff physicians, medical residents or consultant physicians shall write medication orders and prescriptions. (B) A list of those physicians authorized to prescribe medications shall be maintained and regularly updated. (C) A list of licensed staff members authorized to administer medications shall be maintained and regularly updated. (3) Physician's assistants and nurse practitioners may write medication orders, or prescriptions consistent with state and federal law. (c) Compliance with 450:17-3-81 shall be determined by on-site observation and a review of the following: clinical records, written policy and procedures, and roster of licensed, credentialed staff. 450:17-3-82. Medication clinic, medication monitoring (a) Medication administration, storage and control, and consumer reactions shall be Unofficial Copy: OAC Title 450:17 23 Effective 07/01/03
regularly monitored. (b) Facilities shall assure proper storage and control of medications, immediate response if incorrect or overdoses occur, and have appropriate emergency supplies available if needed. (1) Written procedures for medication administration shall be available and accessible in all medication storage areas, and available to all staff authorized to administer medications. (2) All medications shall be kept in locked, non-consumer accessible areas. Conditions which shall be considered in medication storage are light, moisture, sanitation, temperature, ventilation, and the segregation and safe storage of poisons, external medications, and internal medications. (3) Telephone numbers of the state poison centers shall be immediately available in all locations where medications are prescribed, or administered, or stored. (4) A qualified physician shall supervise the preparation and stock of an emergency kit which is readily available, but accessible only to staff. (c) Compliance with 450:17-3-82 shall be determined by on-site observation and a review of the following: written policy and procedures, clinical records, and PI records. 450:17-3-83. Medication clinic, error rates (a) Medication administration or dispensing or medication orders and prescriptions shall be accomplished with no more than three percent (3%) error rate each month. Random selection of at least one-third (1/3) of the months within the period under review shall be surveyed by the CMHC in accordance with facility policies. (b) Compliance with 450:17-3-83 shall be determined by a review of the following: facility policies; PI logs; data; and reports. 450:17-3-84. Availability of medications in a CMHC's community living setting (a) This standard applies to a CMHC's residential program(s) not having on-site medical staff. (b) The CMHC shall have policy and procedures governing consumer access to medications and shall include, at least, the following items: (1) Non-medical staff and volunteers shall not dispense or administer medication; (2) Medication shall be not withheld from consumers for whom it is prescribed, for nonmedical reasons: (3) Prescribed medication shall be stored in a non-resident area that shall be kept locked, except those medications which may be needed by the consumer on an emergency basis; (4) Only medication and medical supplies shall be stored in a non-resident area apart from the medication storage area. (5) Consumers in non-medical settings shall keep a log of all self-administered medications. Unofficial Copy: OAC Title 450:17 24 Effective 07/01/03
(c) Compliance with 450:17-3-84 shall be determined by on-site observation; and a review of the following: clinical records, medication logs, and policy and procedures. 450:17-3-85. Pharmacy Services (a) The CMHC shall provide specific arrangements for pharmacy services to meet consumers psychiatric needs. Provision of services may be made through agreement with another program, through a pharmacy in the community, or through the CMHC's own Oklahoma licensed pharmacy. (b) Compliance with 450:17-3-85 shall be determined by a review of the following: clinical records; written agreements for pharmacy services; on-site observation of in-house pharmacy; and State of Oklahoma pharmacy license. PART 11. CASE MANAGEMENT 450:17-3-101. Case management services, adult (a) Case management efforts shall empower consumers to access and use needed services and meet self-determined goals. These services include resource skills development, consumer advocacy and rehabilitation services provided in various settings based on consumer need. (b) Case management services shall be made available to all adults who have a serious mental illness, and shall provide the following: (1) Screening to determine their need for case management services, which shall include evidence the following were evaluated: (A) Consumer s level of functioning within the community; (B) Consumer s job skills and potential; (C) Client strengths and resources; (D) Consumer s present living situation and support system; (E) Consumer s needs or problems which interfere with the ability to successfully function in the community; (2) Emergency services and emergency assistance; and (3) Service planning and monitoring, which shall address issues and problems identified in the consumer evaluation and shall also: (A) Incorporate needed referral sources to address identified consumer needs; (B) Be developed jointly between the case manager and the consumer; (C) Address the frequency of case management services specified in the treatment plan; and (D) Be incorporated into the treatment plan and monitored at least every six (6) months. (c) Compliance with 450:17-3-101 shall be determined by on-site observation and a review of the following: clinical records, and written policy and procedures. Unofficial Copy: OAC Title 450:17 25 Effective 07/01/03